General and Digestive Unit, Central Hospital of Defense Gómez Ulla, Glorieta del Ejército, 1, Madrid, (28047), Spain.
University of Alcalá de Henares, Madrid, Spain.
BMC Gastroenterol. 2024 Feb 14;24(1):71. doi: 10.1186/s12876-023-03114-6.
Current scientific evidence has pointed out the relevance of hemostatic products for improving clinical outcomes in liver trauma, including increased survival rates and reductions in bleeding-related complications. The purpose of this study was to compare the use of the gelatin-thrombin flowable (Flowable) versus the standard technique of Packing in a new experimental liver injury model.
Twenty-four swine were prospectively randomized to receive either Flowable or standard packing technique. We used a novel severe liver injury model, in which the middle and left suprahepatic veins were selectively injured, causing an exsanguinating hemorrhage. The main outcome measure was the percentage of lost blood volume.
The median total percentage of total blood volume per animal lost, from injury to minute 120, was significantly lower in the Flowable group (15.2%; interquartile range: 10.7-46.7%) than in the Packing group (64.9%; Interquartile range: 53.4-73.0%) (Hodges-Lehmann median difference: 41.1%; 95% CI: 18.9-58.0%, p = 0.0034). The 24-hour survival rate was significantly higher in the Flowable group (87.0%) than in the Packing group (0.0%) (Hazard ratio (HR) 0.08; 95% confidence interval 0.102 to 0.27; p < 0.0001). Mean-arterial pressure was significantly lower at minute 60 and 120 in the Flowable group than in the packing group (p = 0.0258 and p = 0.0272, respectively). At minute 120, hematocrit was higher in the Flowable than in the packing group (Hodges-Lehmann median difference: 5.5%; 95%CI: 1.0 to11.0, p = 0.0267). Finally, the overall-surgical-procedure was significantly shorter with Flowable than with Packing (Hodges-Lehmann median difference: 39.5 s, 95% CI: 25.0 to 54.0 s, p = 0.0004).
The use of the Flowable was more effective in achieving hemostasis, reducing blood loss, and improving survival rates than standard packing in a severe porcine-liver bleeding model.
目前的科学证据指出，止血产品对于改善肝外伤的临床结果具有相关性，包括提高存活率和减少与出血相关的并发症。本研究的目的是比较在新的实验性肝损伤模型中使用明胶-凝血酶可流动（Flowable）与标准填塞技术的效果。
24 头猪前瞻性随机分为接受 Flowable 或标准填塞技术。我们使用了一种新的严重肝损伤模型，其中选择性损伤肝上下腔静脉，导致出血性出血。主要观察指标是动物失去的总血容量百分比。
从损伤到第 120 分钟，每只动物总血容量损失的中位数百分比在 Flowable 组（15.2%；四分位距：10.7-46.7%）明显低于填塞组（64.9%；四分位距：53.4-73.0%）（Hodges-Lehmann 中位数差异：41.1%；95%CI：18.9-58.0%，p=0.0034）。Flowable 组 24 小时生存率明显高于填塞组（87.0%对 0.0%）（风险比（HR）0.08；95%置信区间 0.102 至 0.27；p<0.0001）。Flowable 组在第 60 分钟和 120 分钟时平均动脉压明显低于填塞组（p=0.0258 和 p=0.0272）。在第 120 分钟时，Flowable 组的血细胞比容高于填塞组（Hodges-Lehmann 中位数差异：5.5%；95%CI：1.0 至 11.0，p=0.0267）。最后，Flowable 的总体手术时间明显短于填塞（Hodges-Lehmann 中位数差异：39.5 秒，95%CI：25.0 至 54.0 秒，p=0.0004）。
在严重猪肝出血模型中，与标准填塞相比，Flowable 在实现止血、减少失血和提高存活率方面更有效。
